Takada A, Takase S, Tsutsumi M
Division of Gastroenterology, Department of Internal Medicine, Kanazawa Medical University, Ishikawa Japan.
Gastroenterol Jpn. 1993 Feb;28(1):137-48. doi: 10.1007/BF02775019.
The characteristics of alcoholic liver disease (ALD) in Japanese patients were reviewed and compared with those in Western countries. From the study in Japanese cases, it became clear that alcoholic fibrosis and chronic hepatitis induced by alcohol were types of ALD other than the traditional 3 types. Liver injury in Japanese cases was clearly milder than that in American cases. In American cases, the injury may be fully developed, because of greater alcohol and fat intake. This may be one reason why the two above types of ALD have not been mentioned in the literature of Western countries. In Japanese patients, hepatitis C virus (HCV) infection is not related to alcoholic fibrosis and alcoholic hepatitis. On the other hand, the prevalence of HCV markers was high in chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC) patients. Alcoholic hepatitis and chronic hepatitis are the high risk groups for the development of cirrhosis and the chronic hepatitis group is at high risk for the development of HCC. Although the risk is low in alcoholic fibrosis, some patients also develop cirrhosis. About half of the cases of cirrhosis may develop from alcoholic hepatitis and alcoholic fibrosis, and the remaining half cases may develop from chronic hepatitis. Over 80% of HCC cases may develop from chronic hepatitis in Japan. Chronic alcoholism enhanced the development of HCV-related HCC. Recent increase of HCC in alcoholic cirrhosis in Japan may be related to the increase of alcohol consumption, the increase of blood transfusions, and longer survival of cirrhosis patients.
对日本患者酒精性肝病（ALD）的特征进行了回顾，并与西方国家患者的特征进行了比较。从对日本病例的研究中可以清楚地看出，酒精性纤维化和酒精性慢性肝炎是除传统三种类型之外的ALD类型。日本病例中的肝损伤明显比美国病例中的肝损伤轻。在美国病例中，由于酒精和脂肪摄入量更高，损伤可能已充分发展。这可能是西方国家文献中未提及上述两种ALD类型的原因之一。在日本患者中，丙型肝炎病毒（HCV）感染与酒精性纤维化和酒精性肝炎无关。另一方面，慢性肝炎、肝硬化和肝细胞癌（HCC）患者中HCV标志物的患病率较高。酒精性肝炎和慢性肝炎是肝硬化发生的高危人群，慢性肝炎组是HCC发生的高危人群。虽然酒精性纤维化患者发生肝硬化的风险较低，但一些患者也会发展为肝硬化。约一半的肝硬化病例可能由酒精性肝炎和酒精性纤维化发展而来，其余一半病例可能由慢性肝炎发展而来。在日本，超过80%的HCC病例可能由慢性肝炎发展而来。慢性酒精中毒会促进HCV相关HCC的发生。日本酒精性肝硬化患者中HCC近期的增加可能与酒精消费量的增加、输血次数的增加以及肝硬化患者生存期的延长有关。
